Alev Akyol Erikci

Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia

The aim of this cohort is to investigate whether any haematologic changes detectable by simple complete blood count (CBC) precede pre‐eclampsia development and the diagnostic value of these markers in clinical practice for prediction of pre‐eclampsia.

HLA-G expression in B chronic lymphocytic leukemia: a new prognostic marker?

Abstract Chronic lymphocytic leukemia (CLL) is characterized by a malignant clonal population of lymphocytes, which are usually of the B cell lineage. Classical Rai and Binet staging of CLL is being superseded by new prognostic markers. The mutational status of the immunoglobulin variable region heavy-chain genes segregates the disease into more benign and more malignant versions, and has been confirmed as an important prognostic marker in prospective clinical trials. A search for surrogate markers for this assay has led to flow cytometric assays for CD38 and ZAP-70 expression. The human leukocyte antigen G (HLA-G) molecule exhibits limited tissue distribution and a low polymorphism that generate seven HLA-G isoforms. HLA-G exerts multiple immunoregulatory functions. Recent studies indicate an ectopic up-regulation in tumor cells that may favor their escape from anti-tumor immune responses. For this report we studied HLA-G in parallel with CD38 and ZAP-70 in B-cell chronic lymphocytic leukemia (B-CLL) patients. HLA-G expression was studied retrospectively in circulating B-CLL cells from 20 patients by flow cytometry using the anti-HLA-G specific monoclonal antibody MEM/G9. The proportion of leukemic cells expressing HLA-G varied from 1 to 34%. We detected a statistically significant correlation between HLA-G positive (>12%) expression and progression free survival (p=0·045), but no correlation with CD38 and ZAP-70. We also detected a statistically significant difference between Binet stage A; B and C (p=0·046) and a positive correlation between IL-10 and HLA-G (p=0·044). We conclude that positive HLA-G has an effect on progression - free survival, when compared with CD38 and ZAP-70.

Could mean platelet volume be a predictive marker for gestational diabetes mellitus

Abstract Background: Gestational diabetes mellitus is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Early diagnosis of this complication and appropriate treatment aimed at tight control over maternal glucose levels may positively influence the perinatal outcome. There are studies, which suggest platelets play a role in the pathogenesis of gestational diabetes mellitus. Aim: The aim of this study is to compare the platelet count and other platelet parameters in gestational diabetic and normal pregnant women and to investigate whether these parameters have a predictive significance in gestational diabetes mellitus. Materials and methods: Thirty four women with gestational diabetes mellitus and 45 normal pregnant women were enrolled into the study. Results: Women with gestational diabetes mellitus had lower platelet counts and higher mean platelet volume (MPV) values which were statistically significant (p <0·006 and p <0·0001), respectively. Conclusion: Our results indicate that platelet count and MPV play an important predictive role in gestational diabetes mellitus.

Relationship between anaemia and cognitive functions in elderly people

BACKGROUND The primary goal of the present study was to investigate the effects of anaemia on the cognitive functions and daily living activities in elderly people. METHODS This sectional study was performed using 180 elderly people. Face-to-face interviews and questionnaires were conducted to evaluate daily activities. To evaluate cognitive functions we used the Folsteins Mini-Mental State Examination (MMSE). RESULTS The mean age of the anaemic group and the nonanaemic group were 76.0+/-11.7 and 72.5+/-15.2 years, respectively. The average haemoglobin level among the anaemic population was 10.4 g/dL compared with 13.6 g/dL among the nonanaemic population; a statistically significant difference. There was more impairment in functional status (Katz ADL) (6.8+/-4.3 vs 9.3+/-3.7) and cognition (MMSE) (17.9+/-6.4 vs 21.7+/-6.7) in anaemic than nonanaemic groups, respectively. Albumin and body mass index were lower and the percentage of two or more comorbidities was higher in anaemic group compared to the nonanaemic group, which was a statistically significant variation. The anaemic group was more dependent in terms of bathing, dressing, toileting and transferring. CONCLUSION In the elderly anaemic group, the dependency for daily activities that require physical effort was higher compared to the nonanaemic group. The MMSE score in the elderly anaemic group was lower than subjects who had normal haemoglobin levels. We conclude that anaemia may impair cognitive functions and some daily living activities in the elderly.

The Efficacy of Helicobacter pylori Eradication in the Treatment of Idiopathic Thrombocytopenic Purpura – The First Study in Turkey

medicine department. The overall median age was 52.5 years (range 16–93). The median age of the 20 patients was 50.8 years (range 21–81). Platelet counts ranged between 14 and 87 ! 10 9 /l (median 38.3 ! 10 9 /l). They received antibiotic therapy for H. pylori eradication (amoxicillin 1,000 mg, clarithromycin 500 mg, and lansaprazole 15 mg twice a day for 14 days). Patients were reevaluated 1 month after the eradication therapy by the urea breath test. The platelet count was monitored monthly in the fi rst year and every 2 months thereafter. Response to treatment was defi ned as partial (PR) if the platelet count was between 100 and 150 ! 10 9 /l and complete (CR) if the platelet count was 1 150 ! 10 9 /l. The others were recorded as non responders (NR). H. pylori eradication was achieved in 18/20 cases (90%). Table 1 shows the main features of the patients and the mean follow-up period with preand posttreatment platelet counts. We achieved normal platelet counts in 8/20 cases (40%) in the fi rst month of eradication therapy (fi g. 1, 2). The median platelet count was 39.7 8 19.2 ! 10 9 /l before and 164.2 8 63.2 ! 10 9 /l after eradication, which was statistically meaningful (p ! 0.05). The mean followup period was 13 months. Five out of 8 patients achieved CR. The median platelet count was 193 ! 10 9 /l and Helicobacter pylori is a gram-negative bacterium that is the main cause of gastritis and peptic ulcer disease [1] . It has been implicated in the pathogenesis of some autoimmune diseases, e.g. Sjogren’s syndrome [2] , and recently, in idiopathic thrombocytopenic purpura (ITP). An immunological response to H. pylori infection has been suggested to play a major role in determining gastro-duodenal damage through the production of cytokines and autoantibodies against gastric epithelial cells [3] . There are data consistent with an association between H. pylori infection and a signifi cant increase in platelet count following H.pylori eradication [4] . The aim of this study was to assess the prevalence of H. pylori infection and the effi cacy of eradication therapy in patients with ITP. Between September 2001 and June 2003 we investigated the presence of gastric H. pylori infection in 34 adult ITP patients (12 females, 22 males) consecutively admitted to our hematology department. ITP was diagnosed on the basis of the presence of isolated thrombocytopenia (platelets ! 100 ! 10 9 /l) and megakaryocytic hyperplasia in bone marrow. Other causes of thrombocytopenia (pseudothrombocytopenia, hepatitis C virus infection, human immunodefi ciency virus infection, drugs, and malignancy) were excluded. Twenty out of the 34 prospectively enrolled ITP patients (59%) had documented H. pylori infection by the urea breath test in our nuclear Received: March 21, 2005 Accepted after revision: November 25, 2005

High frequency of MEFV gene mutations in patients with myeloid neoplasm

We aimed to investigate the rate of MEFV, the gene mutated in familial Mediterranean fever, mutations in patients with myeloid neoplasm and to determine if known mutations of MEFV cause a tendency for myeloid neoplasms. The frequency of the five most common MEFV gene mutations (M694V, M680I, V726A, E148Q and M694I) was determined in 26 patients with myeloid neoplasm. We identified 1 homozygous (E148Q/E148Q), 1 compound heterozygous (M694V/E148Q) and 5 heterozygous MEFV gene mutations; none had their own and/or family history compatible with familial Mediterranean fever. The mean overall mutation rate was 0.269. We found a high frequency of carriers in patients with myelodysplastic syndrome (66.6%), polycythemia vera (33.3%) and acute myeloid leukemia (28.6%). However, there was no MEFV gene mutation in patients with chronic myeloid leukemia. In conclusion, this study reports for the first time a possibly high prevalence of MEFV gene mutations in patients with myeloid neoplasm, especially myelodysplastic syndrome, polycythemia vera and acute myeloid leukemia. Our findings could open new perspectives for MEFV gene mutations in myeloid neoplasms and its association with tumor promotion. Further research is needed to determine the actual role of MEFV gene mutations in these malignancies.

Sticky Platelet Syndrome in Patients with Uninduced Venous Thrombosis

Objective: Sticky platelet syndrome (SPS) is a common autosomal dominant inherited platelet disorder. SPS is characterized by platelet hyperreactivity and is associated with arterial and venous thrombosis. The aim of this study was to determine the role of SPS in patients with uninduced venous thrombosis. Material and Methods: The study included 28 patients (15 male and 13 female) with uninduced venous thrombosis. SPS was defined according to Mammen’s aggregation method, which is described in detail elsewhere. Results: According to the defined ranges for platelet hyperreactivity, 3 (50%) patients, 2 (33%), and 1 (17%) (n =6 [21%]) with a confirmed diagnosis were classified as type II, I, and III SPS, respectively. In 1 patient SPS was the only hereditary abnormality noted. The other 5 patients carried other inherited coagulation defects, in addition to SPS. Conclusion: The present findings indicate that the prevalence of SPS was 21% in the patients with uninduced venous thrombosis. We therefore suggest that SPS should be considered in the differential diagnosis of such cases. Conflict of interest:None declared.

Acute Myeloid Leukemia Complicating Multiple Myeloma: A Case Successfully Treated With Etoposide, Thioguanine, and Cytarabine

BACKGROUND The association of acute leukemia and multiple myeloma (MM) has been usually described not only as a complication of chemotherapy but also in the absence of chemotherapy or together at the time of diagnosis. Such leukemias are typically acute myeloid leukemia (AML). The myelomonocytic subtype is particularly found. CASE REPORT We report a case of a 68-year-old female who developed AML 2 years after the diagnosis of light chain (kappa) myeloma. She had been treated with oral melphalan and prednisone for MM. The patient was treated with an anthracycline-lacking therapy consisting of etoposide 120 mg/m2, thioguanine 100 mg/m2 orally twice daily on 1-5 days, and cytarabine 40 mg/m2 subcutaneously on day 1 (ETC) because of poor cardiac performance. CONCLUSION Following ETC therapy our particular patient has been in complete hematologic remission for 29 months. This therapy might be a safe alternative in secondary leukemia especially for elderly patients.

Results of combination therapy with amifostine, pentoxifylline, ciprofloxacin and dexamethasone in patients with myelodysplastic syndrome and acute myeloid leukemia

Abstract Myelodysplastic syndrome (MDS) is a clonal disease of the bone marrow characterized by abnormal hematopoiesis and cytopenias. It has been shown that abnormal cytokine production together with apoptosis are major contributors to the cytopenias associated with the disorder. As the interaction of cytokines plays a role in the pathogenesis, suppression of the cytokine production by the administration of the combination of pentoxyfilline, ciprofloxacin, and dexamethasone (PCD combination) has resulted in the correction of at least some aspects of the cytopenias in the majority of patients and in complete hematologic remission in a small percentage. The aminothiol prodrug amifostine, a compound to protect tissues from cytotoxic drugs and radiotherapy has been found to stimulate proliferation of normal hematopoesis and suppress apoptosis in patients with MDS. In this study we report the results of combination therapy of amifostine and PCD in 12 patients with MDS and acute myeloid leukemia (AML). Amifostine was given in a dose of 200 mg/m2, as an i.v. infusion administered in 10 min, three times a week; pentoxyfilline 2400 mg/day, (3 × 800 mg) p.o.; ciprofloxacine, 1 g/day p.o.; dexamethasone 4·5 mg/day p.o. We achieved 66% response rate in our patients. In some cases responses were achieved in only thrombocytopenia or anemia whereas in others responses were achieved in multiple series. As a result it was found that amifostine + PCD combination may be beneficial in reversing cytopenias in the treatment of MDS and AML and is worth further study.

Platelet indices in patients with colorectal cancer

The interaction between cancer cells and platelets has been known for a long time. Although platelet indices have been also investigated in several clinical settings, it has not been exactly demonstrated in cancer patients. We investigated platelet indices in colorectal cancer patients and compared with healthy subjects. Two hundred and twenty-one colorectal cancer patients and 110 healthy subjects were enrolled into the retrospective study. Data were obtained from computerized medical records of our hospital. Medical record review was performed for all patients regarding thrombocyte indices. Platelet count (325.000/mm3 ± 265.000/mm3 vs 267.000/mm3 ± 67.000/mm3; p=0.025; respectively) and plateletcrit (Pct) (0.25% ± 0.10 vs 0.21 ± 0.05; p<0.001; respectively) were increased in patients compared with healthy subjects while mean platelet volume (MPV) and platelet distribution width (PDW) were similar. The platelet indices were not related to existence of metastasis or acute abdomen. Platelet count and Pct, but not MPV and PDW, are elevated in colorectal cancer patients. Future studies that investigate platelet morphology, function, and putative role of platelets in tumorigenesis and metatasis should be established.